Get Started
1
Please select which of the following you are concerned about or would like to discuss with your provider.
ADHD/ADD
Depression
Anxiety
Psychotherapy
Bipolar
Schizophrenia
OCD
Other
None of these
2
Create an account to save your progress
First name
Mandatory field
*
Last name
Mandatory field
*
Email address
Mandatory field
*
Phone number
Mandatory field
*
We will send important appointment and prescription notifications to your email address and phone number
3
What is your biological sex?
Your biological sex is important for your doctor to make medical decisions.
Female
Male
4
When were you born?
Your birthdate helps your doctor make medical decisions. This information will be kept confidential.
Birthdate (MM/DD/YYYY)
Mandatory field
*
5
Let's start with the basics
Please answer the next 6 questions based on how you have felt and conducted yourself over the past 6 months.
If you are currently on ADHD medication, please answer the questions based on how you feel when you are not on the medication.
